More evidence of how patients overestimate benefit of screening

A new paper published in the Annals of Family Medicine, “Patients’ Expectations of Screening and Preventive Treatments,” concludes:

“Patients overestimated the risk reduction achieved with 4 examples of screening and preventive medications.  This tendency to overestimate benefits may affect patients’ decisions to use such interventions, and practitioners should be aware of this tendency when discussing these interventions with patients.”

That’s based on questionnaire responses from 354 people ages 50-70.

“Participants overestimated the degree of benefit conferred by all interventions: 90% of participants overestimated the effect of breast cancer screening, 94% overestimated the effect of bowel cancer screening, 82% overestimated the effect of hip fracture preventive medication, and 69% overestimated the effect of preventive medication for cardiovascular disease. Estimates of minimum acceptable benefit were more conservative, but other than for cardiovascular disease mortality prevention, most respondents indicated a minimum benefit greater than these interventions achieve.”

The paper is from New Zealand, described in the paper has having “a well-developed primary care system with a high uptake of preventive interventions.”

It’s a different story – but much the same story – in the US, due to the American perspective about screening and prevention. A couple of papers on the topic:

Gerd Gigerenzer and colleagues at the Harding Center for Risk Literacy in Berlin wrote, “Public Knowledge of Benefits of Breast and Prostate Cancer Screening in Europe.”

Here’s how the Annals paper concluded:

“Doctors may also have a poor understanding of the magnitude of benefit of some preventive treatments and have difficulty in interpreting the results of screening tests, which may impair their ability to facilitate informed decision making by their patients.

We did not assess patients’ perceptions of the harms associated with screening and preventive interventions, but this consideration is equally important for a patient deciding whether to accept such an intervention. The communication of harm has been less well studied than the communication of benefit, but it is likely that perception of harms is affected by the method with which they are described.

Our findings suggest that doctors should be aware that many patients have overly optimistic expectations of the benefits of preventive interventions and screening. This misperception may impair informed decision making about the use of such interventions, and physicians should consider using decision aids with patients when discussing these interventions. The use of decision aids may be particularly important when discussing these interventions with older patients and those with a lower level of education.”

Finally, I remind all readers of this blog that our project has found a clear pattern of news stories that include claims about medical interventions  (>1,800 reviewed in 6.5 years) that tend to emphasize/exaggerate benefits and minimize/ignore harms.  As a journalist, I ask all journalists to look in the mirror first.

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Comments (2)

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@kgapo kathi apostolidis

November 19, 2012 at 1:32 pm

Thanks fro bringing up this paper on screening expectations of patients. Already yesterday, while driving I heard on the radio an urologist being adamant that all men over 50 must have a yearly PSA test. Elsewhere, last month tv and radio messages and awareness campaigns of breast cancer patient groups shouted out in all tones that early breast cancer screening saves lives. But what how early is defined? what kind of screening? These are kept under silence.. Any attempts to say something different like that maybe early is not 25yrs old women, that screening is not mammography for all, that mammography is not a benign procedure and that the simple fact of having a mammogram is not a cure, are met with hostility and anger….. Here, one can see the impact of false information that passes from journalists of all media to the public… after all, I was told that the foregoing was on TV by prominent physiciants… No further comments..